Improving the safety and quality of care for older adults by reducing harmful or unnecessary medicines through effective, evidence‑based deprescribing in hospitals tested at large scale.
Why is the research needed?
As we get older, our bodies are less able to handle some medicines. Medicines that were once effective and safe, can become less beneficial, with increased risk of harm. Half of older people in hospital are prescribed a medicine with a safety risk but these medicines are rarely stopped. Nine out of ten patients and carers believe that risky medicines should be stopped in hospital and that doctors should start the discussion. To make this happen, we need to change doctor and pharmacist behaviour so that the idea of stopping medicines is more likely to be discussed with patients.
Our earlier research with 54 doctors and pharmacists working with older people, found one thing that helps (drawing attention to prescribers who successfully stop risky medicines) and four things that hinder (wrong belief that patients don’t want to stop, pharmacists being unavailable when stopping decisions could be made, thinking that doing nothing is safer than stopping and medicine stopping is not a hospital priority).
What are we doing?
In older people’s medicine wards we aim to develop our approach to increasing discussions with patients about stopping medicines by using what helps and removing what hinders, develop a list of things that people think are important to measure when stopping medicines in hospital, design and carry out a study testing whether our approach works and is value for money, and make discussions about medicines stopping in hospital important.
The project is a practitioner behaviour change intervention designed to increase proactive deprescribing. We completed the feasibility study across four hospitals in England in 2022. the CHARMER definitive trial began in February 2024, with twenty‑four hospitals, working alongside Health Innovation East to support implementation across the sites. The trial completed recruitment on 31 July 2025, with follow up completed at the end of October 2025. More than 41,000 older adult patients, and 248 geriatricians and pharmacists were involved in the trial.
We are now in the process of analysing the data, with results to be released later in 2026.
How are we working with communities, services and organisations?
We worked with patients, carers, and staff from hospital and community to develop ways to support pharmacists and doctors to have conversations with patients and carers about stopping risky medicines. Following small-scale testing we worked with 24 hospitals to see if more medicines are stopped with our approach compared to without our approach. We want to see if our approach will provide additional benefits to patients, such as preventing hospital readmissions or improving quality of life. We will calculate the cost of our approach in such a way that the government can compare it with other services.
Participating sites will be provided with templates and guidance which will allow for trusts to create local actions plans that consider their unique situations. The guidance and templates will be designed in such a way that it could be easily taken up in different hospitals and will be made freely available.
What will the impact and benefits of this research be?
If the CHARMER intervention is shown to be effective and cost-effective, roll out of this intervention will support geriatricians and pharmacists to do more proactive deprescribing and have discussions with older people and their families about stopping medicines that are no longer needed or may cause harm in the future. Older people will benefit as our previous research has shown that they expect their medicines to be reviewed in hospital and any medicines no longer needed or with a high chance of harm in the future, to be stopped.
What do we have planned for knowledge mobilisation and implementation?
We will use the learning from the trial around implementation of CHARMER and any contextual factors that influence this and how the intervention is received. If CHARMER is shown to be both effective in facilitating geriatricians and pharmacists to identify opportunities for proactive deprescribing and initiate deprescribing conversations with older adults in hospital, and cost-effective, then we will look to roll out the intervention nationally.
Related papers, outputs and resources
Read Work Package 5 - Dissemination - CHARMER Study
Read the CHARMER highlights newsletter
Sign up to CHARMER highlights newsletter
Watch the Ageing Specialty Research webinar held by the CHARMER team:
Who is involved?
- Co-Principal Investigator: Professor Debi Bhattacharya, University of East Anglia
- Co-Principal Investigator: Professor David Wright, University of East Anglia
- Project Lead for Implementation: Luke Natali, Health Innovation East
- Patient and Public Involvement Lead: Mr Graham Prestwich, University of Leicester
- Programme Manager: Jackie Martin-Kerry, University of East Anglia
- Janet Gray, University of East Anglia
- Jennie Griffiths, University of East Anglia
- David Taylor, University of East Anglia
- Sujata Walkerley, University of East Anglia
- Dr Sion Scott, University of East Anglia
- Dr Allan Clark, University of East Anglia
- Mr David Turner, University of East Anglia
- Dr Martyn Patel, Norfolk and Norwich University Hospitals NHS Foundation Trust
- Professor David Alldred, University of Leeds
- Dr Ian Kellar, University of Sheffield
- Dr Jo Taylor, University of York
- Professor Miles Witham, Newcastle University
- Dr Victoria Keevil, University of Exeter
- Michael Sheridan, Norfolk and Norwich University Hospitals NHS Foundation Trust
- Lizzie Bywater-Florance, University of East Anglia
- Dr Bethany Atkins, University of East Anglia
- Gina Gohil, University of East Anglia
- Amber Hammond, University of East Anglia
- Antony Colles, University of East Anglia
- Erika Sims, University of East Anglia
- Kelly Grant, University of East Anglia
- Martin Pond, University of East Anglia
- Edith Cassidy, University of East Anglia
- Hannah Browning, University of East Anglia
Get in contact
Email Luke Natali or the CHARMER team at luke.natali@healthinnovationeast.co.uk or charmer.study@leicester.ac.uk.
